pulmonary hydatid cyst
Helminthiases / / August 12, 2017
from organs and tissues of the chest cavity hydatid disease strikes most often the lungs.The share of light in this disease accounts for 23.7% of cases.Other localization of hydatidosis in the thoracic cavity - the pleura, mediastinum tissue, diaphragm, esophagus, heart - are rare.
Depending on the penetration into the lungs hexacanth distinguish primary and secondary hydatid disease of the lungs.Primary hydatid disease is caused by hexacanth penetration into the lungs from the external environment.In secondary echinococcosis in the light of the fall scolexes existing in humans hydatid cysts.Primary hydatid disease of lungs is observed more often secondary.
parasite penetration into the lungs during the initial echinococcosis occurs most frequently from the gastrointestinal tract.Most hexacanth that fall into the flowing blood from the intestine, is retained in the capillaries of the liver.Only some of the anastomosis can pass between the branches of the portal and hepatic veins in the inferior vena c
Entering the parasite in the respiratory tract occurs more often in hot dry climate with strong winds.Perhaps that is why lung hydatid disease in these geographical areas is more common compared to other sites echinococcosis.
Secondary hydatid lung develops as a result of implantation of the parasite during puncture or surgery, as well as the breakout hydatid cyst into the pleural cavity and the bronchial tree.
In patients with primary pulmonary echinococcosis cysts localized in the right and left lung is observed at approximately the same frequency.In most cases, it revealed a cyst, much less is 2-5 cysts.The lower the proportion of affected slightly more often the top.With deep cyst location completely surrounded by pulmonary parenchyma, and when the surface is usually protrude above the surface of the lungs.
Combined defeat echinococcosis of lungs and other organs, especially the liver, occurs in approximately 10% of cases.
cysts in the lungs vary from barely noticeable to gigantic, occupying half or even more than half of the chest cavity.Large cysts compress the adjacent bronchi and often lead to segmental atelectasis and even equity.Atelectatic share can be located on the surface of the cyst in the form of a thin plate.
In the central regions of the lungs due to obstacles in the form of the bronchi and large cysts rarely become large vessels.The rate of growth of cysts is usually relatively slow, but it is not always uniform.Sometimes slow-growing cyst in a short time can increase dramatically in size.Other cysts even a single patient can grow quite different rates.A distinctive feature of hydatid cysts located in the lungs, is a relatively rare bubbles subsidiary content (6-7% of cases).
The clinical course of pulmonary echinococcosis Dieulafoy even in 1897 proposed to divide into three stages: latent, which developed a cyst stage and the stage of the perforated cyst.The first stage takes place without any clinical symptoms.It lasts from the beginning of the development of the parasite in humans until the first signs of the disease.Echinococcosis light in the first stage is detected only during routine radiographic examination.The second stage is characterized by the appearance of symptoms characteristic of uncomplicated lung cysts.Severity of symptoms depends mainly on the rate of increase in the size of hydatid cysts and their localization.The third stage is usually accompanied by severe, very advanced morphological changes in the lungs and severe clinical symptoms due to the presence of complicated hydatid cysts.
clinical picture of pulmonary echinococcosis studied in sufficient detail.In the first stage of the disease, when there is not penetrated, slow-growing, non-infected cysts, mood changes a little sick.They often do not make any complaints.Sometimes complaints are nonspecific for the Echinococcosis character: a little malaise, urticaria, pruritus.Violation of the normal state of health is mainly for large cysts that cause pressure on the chest wall, squeeze the large vessels, the bronchi and the mediastinal organs, difficult breathing and circulation.When festering cysts condition of patients worsens.
Typical complaints, which may have diseased lung echinococcosis are chest pain, cough, hemoptysis, and dyspnea.Pain is usually felt on the side of the cyst location and at first there are periodic, and then become constant, aggravated by coughing or physical exertion.The nature of pain piercing, pinching or aching.Intense local pain observed in the secondary pleurisy with involvement in the inflammatory process of the parietal pleura and intercostal nerves.
irradiation of pain is different - in the back area of the heart, breast, pit of the stomach.
cough is initially dry.He stubbornly held and difficult to medication.In some cases, the cough is paroxysmal in nature, that children may raise the suspicion of whooping cough.Very typical of persistent cough with cysts located in the root of the lung and diaphragm.As the disease progresses, dry cough, cough can be replaced with a small amount of mucous or muco-purulent sputum.The first symptom, forcing the patient to see a doctor, sometimes hemoptysis.Small streaks of blood in the sputum hemoptysis occurs relatively early due to the destruction of small vessels in the growing cyst circle.Pulmonary bleeding nevskryvshihsya hydatid cysts are very rare.In patients with large and multiple cysts, especially in cases of rapid growth, there is shortness of breath.
The hydatid cyst of the circle, as a rule, there is inflammation, which resulted in around cuticular shell formed fibrous capsule.This inflammation can be caused not only by infection and sensitizing parasite.Clinically, an exacerbation of inflammatory marked deterioration of general condition, fever, sometimes chills and night sweats.May appear or worsen pain and cough, as well as changes in the blood that are typical for allergic process.A similar pattern is observed when infected cyst fluid content.
Diagnosis On examination, patients with lung echinococcosis in which cysts grow large, you can sometimes detect the protrusion of the chest wall, smoothing intercostal spaces, stasis in the subcutaneous veins and even swelling of the chest wall, or upper extremities.Flexing of the chest wall is more often in children and young people in the localization of cysts in the upper lobes of the lungs.Cysts located in the lower lobes may shift the liver and spleen, as well as to compress the inferior vena cava.In some cases, the pressure causes cysts uzuratsii ribs and vertebrae.When intercostal neuritis and involvement in the inflammatory process of the costal pleura marked tenderness intercostal spaces.
nature of the change of respiratory noise depends on the size of the cyst, environmental lung parenchyma and largely from complications during echinococcosis.Breathing on the side of the affected lung may be normal vesicular, impaired, hard, and even bronchial amforicheskim, with dry and moist wheezes.For large cysts and atelectasis breathing can not be heard.In the case of involvement in the inflammatory process of the pleura may be auscultated rubbing pleural sheets.
Among the methods of laboratory research and clinical diagnosis of lung echinococcosis greatest practical importance are studies of peripheral blood, sputum, and serological tests.The most frequent changes in the blood is increased ESR.It is observed in 52% of patients.Less marked lymphocytosis (39%), and eosinophilia (24%), which was previously attached great differential diagnostic value.The degree of eosinophilia is usually associated with the intensity of multiplication of the parasite and hydatid fluid absorption.
main method for diagnosing lung echinococcosis - X-ray examination, which for this purpose Rosenfeld described further in 1897, ie 2 years after the discovery of X-rays...Among the methods of X-ray radiography studies are needed in frontal and lateral projections, tomography and special indications bronchography.A very important role in the detection of lung echinococcosis plays a massive prophylactic fluorography study population.It is possible to provide preventive care at the present time to detect the disease in 30-40% of patients before showing any clinical symptoms.It should be noted that such accident discovered a cyst can reach 08/05/10 cm in diameter.
form a single hydatid cyst in the lung X-ray image, usually round or oval.Often the form is incorrect, as the soft wall cysts are easily deformed by contact in the course of growth with different obstacles - bronchi, vessels, pleural sheets, etc.
large cysts may compress the adjacent bronchi and vessels, in connection with which there are segmental and..equity atelectasis, lung pattern changes.Small cyst can not be seen on conventional radiographs.They help identify tomography.
Specific radiological sign of hydatid cysts in the lung is often considered a symptom Nemenova, which is the shadow of the cyst form changing at breath: at the height of a deep breath cyst changes its shape becomes more oval.However, the value of this symptom is very small.
differential diagnosis of lung echinococcosis should be carried out with non-parasitic cysts, malignant and benign tumors of lung, pleura and mediastinum, tuberculosis, arteriovenous aneurysms, relaxation.
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complications The major complications are lung echinococcosis infection and abscess cyst breakouts cysts in the lumen of the bronchus and pleural cavity.These complications tend to change relatively calm throughout the process and worsen the condition of patients.The infection and abscess nevskryvshihsya hydatid cysts occur in cases of infection through small defects cuticular shell.Typically, suppuration or parasite death precedes or occurs after it.The clinical picture is characterized by cysts festering signs of acute inflammation.With the passage of time in the lung tissue adjacent to the festering cyst, developed morphological changes characteristic of chronic nonspecific pulmonary diseases.
Breakthroughs in bronchial cysts occur much more frequently than breakthroughs in the pleura.According to statistics, the frequency of breakouts varies greatly and depends on the contingent observed patients and surgical treatment of timeliness.According to some reports, the frequency of breakthrough hydatid cysts in the lung bronchi varies from 20 to 40%, and in the pleura - from 2 to 5%.
factors that directly precede a breakthrough cysts and provoke it can be physical stress, harsh cough, vomiting, chest compression.Clinical manifestations breakthrough hydatid cyst in the bronchus can be both very rugged, and blurred.In the most typical, classical cases cysts breakthrough in the bronchus causes severe cough that may be accompanied by a sense of suffocation, the appearance of cyanosis, cold sweat.Patients with coughs significant amount of light, salty taste of liquid, sometimes mixed with blood, with white scraps of cuticular membrane, and sometimes even with small rounded nevskryvshimisya subsidiaries hydatid bubbles.
In some cases, after a cyst in the bronchi and coughing the whole cuticular shell cavity in the lung may be closed and the patient is recovering.This occurs when a thin, pliable fibrous capsule.However, to rely on such an outcome in clinical practice is impossible.Breakthrough cysts more often does not improve, but on the contrary, worsens during the process.The cavity in the lung, if it has not yet been infected, infected, there arises a chronic abscess.Sputum gradually become purulent, sandwich.Clinical and radiological picture of these patients is similar to that in the infected bronchogenic cyst or chronic lung abscess.
Breakthrough hydatid cysts in the lung cavity of the pleura is usually accompanied by pain in the corresponding half of the chest and fever.In some cases, shock may occur.Radiographic findings are similar to those with pleural effusion.
rare complication is the dissemination of tapeworm with the development of secondary pulmonary echinococcosis.The clinical picture of this complication is different bilateral disease, hemoptysis, periodic emptying into the bronchial tree of the individual cysts with expectoration of hydatid fluid.When obliteration of the pleural cavity of the cyst may become evident through the chest wall to form a thoracic fistula.
lung Echinococcosis is subject to surgical treatment.Indications for surgery are usually absolute.Refusal of surgery can only be associated with the general contraindications for major surgery.The operation should be taken as early as possible, preferably with a small brush size and to the development of complications.The outcome of the operation performed under such conditions is much better.
12 Aug, 2017